Hospital infection tied to readmission

Friday

Feb 25, 2011 at 12:01 AM

Jo Ciavaglia @JoCiavaglia

health

Pennsylvanians who developed an infection during a hospital stay were nearly five times more likely to be readmitted than healthy patients, and the highest readmission rates were among older patients and ones who had surgery, a new report released today says.

The latest Pennsylvania Health Care Cost Containment Council report doesn't include hospital-specific infection information, but includes, for the first time, readmissions for patients who contracted infections during a hospital stay, along with death rates, lengths of stay and estimated Medicare payment.

Nationwide, hospitals are more focused on preventing and reducing readmissions as a way to control soaring health care costs. The new health law also includes measures aimed at reducing infections and associated costs, such as lowering Medicare reimbursement for hospitals that fall in the bottom quarter for heart and pneumonia related readmissions.

The average hospital payment in 2009 for a Medicare patient in the state who developed an infection was $20,471, more than three times higher than the $6,615 paid for a patient without an infection, according to the new report. Death rates and hospital stays were also significantly higher among people who developed infections.

But the council also pointed out that some patient outcomes detailed in the report may not have been related to the infection.

"We don't know why that is or how much the initial infection contributes to the readmission but it may present opportunities for quality improvement and cost containment," the council's Executive Director Joe Martin said Monday.

Local hospitals are working to control infections with measures such as screening patients for symptoms at admission and close monitoring of patients with weakened immune systems. But preventing some infections can be extremely challenging, even unavoidable, hospital officials said.

An infection often doesn't appear immediately; bacteria could be present in the surgical site; uncontrolled glucose levels impede wound healing; and an unanticipated time delay can reduce the effectiveness of pre-surgery antibiotics given a patient.

Drug-resistant super bugs, such as C-diff, which affects the gastrointestinal system, are harder to prevent because routine anti-infection methods are not effective.

"(Surgical site infections) are particularly tough because the underlying condition can make (people) more susceptible for infections," said Kate Flynn, president of the Health Care Improvement Foundation in Philadelphia, which has led infection control and reduction initiatives in area hospitals.

Overall, the number of Pennsylvania patients who developed at least one infection during a hospital stay was low - 23,287, or 1.2 percent - of the 1.9 million admitted in 2009, according to the Healthcare-Associated Infections report.

But among patients who did develop infections, 30 percent were readmitted to a hospital within 30 days compared with 6 percent of patients with no infection.

Nearly half the patients who developed infections were age 65 and older, and about 30 percent of them were readmitted in 2009 as a result, compared with about 9 percent among those who didn't develop an infection during a hospital stay. The estimated total Medicare payment for these readmissions was more than $24.6 million.

finding the bugs

Surgical site infections accounted for the largest percentage of infections developed during hospital stays followed closely by urinary tract infections, typically caused by catheters. Together they accounted for nearly half of hospital-associated infections in 2009.

More than three-quarters of the 5,772 patients who developed a surgical site infection had it identified after they left the hospital, the cost containment council found.

That isn't unusual, said Dr. Linda Lavin, medical director at Grand View Hospital in West Rockhill.

Infection symptoms can take up to a week to appear, but patients are in and out of the hospital today, and many surgeries are same-day outpatient procedures, Lavin said.

If the infection is minor, the surgeon typically treats it and the hospital might be notified, Lavin added.

Grand View is making a greater effort to coordinate with surgeons and health care providers so it can be notified if a patient develops a post-op infection, no matter how minor. The information is important in determining the type of infection, how it occurred and taking steps to prevent it, Lavin said.

With surgical infections, hospitals look at all areas, including sterilization process, if the patient showed prior symptoms and how medical care was delivered, said Dr. Joseph Conroy, chief medical officer at St. Mary Medical Center in Middletown.

Addressing potential problems that could impact recovery before surgery (when possible) is another strategy, Conroy said. Orthopedic patients who smoke may be asked to stop in the week before surgery since the habit slows healing. Surgical patients also may be asked to shower with certain shampoos or soaps designed to reduce harmful bacteria counts.

Another pre-surgery strategy with chronically ill patients, such as cancer patients - who were the most prone to readmissions for infections, according to the new report - is to make sure they're as healthy as possible and build their immune systems, Conroy said.

The transition from hospital to home care - and checking to make sure a patient follows discharge instructions - is also critical, said Flynn, of the Health Care Improvement Foundation. Hospitals want to make sure patients see their doctor and continue taking prescribed medications, including antibiotics.

In recent years, Philadelphia area hospitals have done a good job preventing the transmission of the drug-resistant MRSA bacteria, and significantly reducing infections involving medical devices such as mechanical ventilators, Flynn said.

But hospitals must maintain vigilance with infection control measures.

"Bugs have a funny way of morphing and adapting," she added. "We don't know what the next big issue will be."

Jo Ciavaglia can be reached at 215-949-4181 or jciavaglia@phillyBurbs.com. For more health and fitness information, visit Jo's blog, Working My Butt Off, at www.phillyBurbs.com/opinions/blogs/courier_blogs/jo_ciavaglia.html. For the latest health information follow Jo on Twitter at twitter.com/jociavaglia.

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